Physiotherapy based on problem-solving in upper limb function and neuroplasticity in chronic stroke patients: A case series.

RATIONALE, AIMS, AND OBJECTIVES: Upper limb recovery is one of the main concerns of stroke neurorehabilitation. Neuroplasticity might underlie such recovery, particularly in the chronic phase. The purpose of this study was to assess the effect of physiotherapy based on problem-solving in recovering arm function in chronic stroke patients and explore its neuroplastic changes.

METHODS: A small sample research design with a n of 3 using a pre-post test design was carried out. Neuroplasticity and function were assessed by using functional magnetic resonance imaging (during motor imagery and performance), action research arm test, motor assessment scale, and Fugl-Meyer assessment scale, at 3 sequential time periods: baseline(m0-before a 4-week period without physiotherapy), pre-treatment(m1), and post-treatment(m2). Minimal clinical important differences and a recovery score were assessed. Assessors were blinded to moment assignment. Patients1 underwent physiotherapy sessions, 50 minutes, 5 days/week for 4 weeks. Four control subjects served as a reference for functional magnetic resonance imaging changes.

RESULTS: All patients recovered more than 20% after intervention. Stroke patients had similar increased areas as healthy subjects during motor execution but not during imagination at baseline. Consequently, all patients increased activity in the contralateral precentral area after intervention.

CONCLUSIONS: This study indicates that 4 weeks of physiotherapy promoted the recovery of arm function and neuroplasticity in all chronic stroke patients. Future research is recommended to determine the efficacy of this therapy.